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Have Medicare? You may be able to get better access to mental health care this year

The American population is aging—and much-needed mental health care providers are in short supply. Earlier this year, the federal government rolled out new rules to help older Americans access more services and give health care professionals the flexibility to help those in their community with the greatest needs.

But better health care access only works if the people poised to benefit understand the new rules. It's not unusual for Medicare patients to need to advocate for themselves in health care situations, and doing so may help those from underserved communities receive better care.

Foothold Technology analyzed resources from the Centers for Medicare and Medicaid Services, Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, and the Commonwealth Fund to explain how the new Medicare rules will expand access to behavioral health treatment.

The Health Resources and Services Administration reports that 1 in 3 Americans live in a part of the U.S. where there is a shortage of mental health care professionals. The new rules for Medicare, announced in November, are intended to expand avenues to access for patients who can get services covered for mental health and drug use disorders.

Medicare is a federal health insurance program for Americans 65 and older, or younger people who live with disabilities. It's not to be confused with Medicaid, the federal program for Americans with limited incomes.

About 1 in 5 Americans use Medicare, with higher use rates in more rural states like West Virginia, Maine, and Vermont, according to a 2021 analysis by KFF. Recipients often live in underserved communities and tend to have lower incomes, with around 1 in 3 of recipients earning less than 200% of the federal poverty level.

The ongoing shortage of mental health providers nationwide, combined with the increase in mental illness and substance use disorders, has made care hard to find—especially for Medicare and Medicaid users. A report from the Department of Health and Human Services released earlier this year found that Medicare- and Medicaid-covered providers are difficult to come by, forcing some to drive an hour or more for care.

In a December statement, Department of HHS Secretary Xavier Becerra said the rollout of the new rules is part of the government's commitment to "expanding access to behavioral healthcare for people with Medicare."

In particular, the department aims to address gaps in treatment for Medicare recipients in Native American communities, rural communities, and other underserved parts of the country. Many of the changes aim to make it easier for recipients to get early intervention and crisis intervention from the service workers closest to the communities they serve, make care more affordable, and expand access to the potential mental and behavioral health workforce for Medicare beneficiaries.

This Medicare tool allows enrolled Medicare recipients to find providers nearby who Medicare covers. Read on to learn more about the changes coming to Medicare this year.

Expanding billing eligibility

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Family therapists and mental health counselors can bill Medicare directly due to the reforms implemented this year.

CMS will temporarily add health and well-being coaches to covered services under its Medicare Telehealth Services list this year. It's also expanding the health care providers that provide covered behavioral health assessments to provide better physical care. It will begin allowing addiction, drug, and alcohol counselors who meet certain requirements to enroll as mental health counselors under Medicare.

CMS also plans to add a rule this year that allows health providers to pay for caregiver training through Medicare, hoping to expand and enhance the existing caregiving industry.

Addressing rural health care deserts

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This year, CMS will reduce requirements for nurse practitioners, allowing them to provide behavioral health services at rural health clinics and federally qualified health centers. Previously, they had to have certification in providing primary care, but CMS is removing the barrier in order to alleviate staffing shortages. It will also allow those clinics to continue providing telehealth services.

Expanded opioid treatment coverage


As part of its expansion of COVID-era telehealth policies, CMS is also extending a temporary rule that allows Opioid Treatment Programs to bill Medicare for assessments of patients conducted over the phone or online using audio only and no video. With this move, CMS hopes to avoid disruptions to existing access Medicare recipients have to opioid treatment.

Including community health workers and peer support specialists

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Medicare will now allow for the reimbursement of services from more health care specialists, expanding the possible avenues for treatment in places where they might be hard to find.

The new reforms specifically include peer support specialists and community health workers. Peer support specialists help others avoid relapse and maintain their recovery process, a relationship informed by the specialist's lived experiences with conditions like substance use disorder. Community health workers help connect the health care system with the communities they serve.

CHWs work at nonprofits, government agencies, public health departments, and community programs. They can perform educational outreach, counseling, or help people find transportation to appointments. These kinds of workers were integral to the public health response to the COVID-19 pandemic: Studies found CHWs offer support for geriatric patients with complex needs, according to a research review published in a 2022 issue of the Journal of the American Geriatrics Society.

Some states were already making rules to allow for coverage of CHW services, and new Medicaid rules may also expand the number of working CHWs around the country as funding for them is bolstered.

Story editing by Alizah Salario. Copy editing by Kristen Wegrzyn. Photo selection by Lacy Kerrick.This story originally appeared on Foothold Technology and was produced and distributed in partnership with Stacker Studio.


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